NPI | 1134754450 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9648) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 9648) |
Enumeration Date | 2020-03-06 |
Last Update Date | 2020-04-01 |